Beto 200 Zk

Leaflet attached to the packaging: patient information

Warning! Keep the leaflet! Information on the immediate packaging in a foreign language.

Beto 200 ZK (Metoprolol succinate Sandoz retard 200)

190 mg, prolonged-release tablets

Metoprolol succinate
Beto 200 ZK and Metoprolol succinate Sandoz retard 200 are different trade names for the same medicine.

You should carefully read the contents of the leaflet before using the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same as yours.
• If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. See section 4.

Table of contents of the leaflet:

• 1. What is Beto 200 ZK and what is it used for
• 2. Important information before taking Beto 200 ZK
• 3. How to take Beto 200 ZK
• 4. Possible side effects
• 5. How to store Beto 200 ZK
• 6. Contents of the packaging and other information

1. What is Beto 200 ZK and what is it used for

Metoprolol succinate (selective beta-adrenergic blocker), the active substance of Beto 200 ZK, blocks certain beta-adrenergic receptors in the body, mainly located in the heart.
Beto 200 ZK is used:

• to treat high blood pressure,
• to treat chest pain,
• to treat heart rhythm disorders, including accelerated heart rate,
• for the prevention of heart attackafter an acute phase,
• in case of unpleasant sensation of irregular and/or strong heartbeat,
• to prevent migraine,
• to treat heart failure.

In children and adolescents from 6 to 18 years old

• to treat high blood pressure(hypertension).

2. Important information before taking Beto 200 ZK

When not to take Beto 200 ZK

• if you are allergic to metoprolol succinate or any of the other ingredients of this medicine (listed in section 6);
• if you are allergic to other beta-adrenergic blockers;
• if you have severe asthma or severe wheezing;
• if you have shock due to severe heart problems;
• if you have heart conduction disorders (second or third degree atrioventricular block, high degree atrio-sinus block) or heart rhythm disorders (sick sinus syndrome) unless you have a pacemaker
• if you have severe circulatory disorders (severe peripheral arterial disease);
• if you have untreated and uncontrolled heart failure (a disease that usually causes shortness of breath and swelling of the ankles);
• if you have a slow heart rate (<50 beats min at rest before treatment);< li>
• if you have very low blood pressure (systolic blood pressure <90 mmhg);< li>
• if you have a more than usual acidic blood reaction (so-called metabolic acidosis);
• if you are taking any of the following medicines:
• monoamine oxidase inhibitors (MAOIs) - medicines used to treat depression;
• verapamil and diltiazem (medicines used to lower blood pressure);
• anti-arrhythmic drugs, such as disopyramide (medicines used to treat irregular heart rhythm).

In patients with chronic heart failure, metoprolol should not be used if:

• they have unstable, uncontrolled heart failure (which may be manifested by fluid accumulation in the lungs, poor circulation, or low blood pressure).
• they are constantly or periodically receiving drugs that increase the strength of heart contractions.
• they have a slow heart rate (less than 68 beats/min at rest before treatment).
• their systolic blood pressure is consistently less than 100 mmHg.

Warnings and precautions

Before starting to take Beto 200 ZK, you should discuss it with your doctor or pharmacist if:

• you have asthma, bronchitis, or lung function disorders;
• you have heart function disorders (e.g. slow heart rate) or circulatory disorders (taking Beto 200 ZK may worsen their course);
• you have diabetes;
• you have thyroid function disorders;
• you have severe liver disease;
• you have had a severe allergic reaction to any allergen;
• you have a rare form of angina pectoris, so-called Prinzmetal's angina;
• you need to undergo surgery that requires general anesthesia. You should inform the anesthesiologist about taking Beto 200 ZK.
• you have a tumor of the adrenal gland that secretes hormones (pheochromocytoma): in such a case, it is necessary to use a medicine that blocks alpha-adrenergic receptors beforehand and at the same time.
• you have psoriasis.

Taking metoprolol may cause positive results in anti-doping tests.

Children and adolescents

Experience with treatment in children under 6 years of age is limited.
Beto 200 ZK should not be used in children under 6 years of age.

Beto 200 ZK and other medicines

You should tell your doctor or pharmacist about all medicines you are taking or have recently taken, as well as any medicines you plan to take.
Beto 200 ZK interacts with many other medicines.

• Medicines used to treat high blood pressure (including prazosin, clonidine, hydralazine, guanethidine, betanidine, reserpine, alpha-methyldopa, and so-called calcium antagonists, such as verapamil, diltiazem, or nifedipine).
• Other beta-adrenergic blockers (also those contained in eye drops).
• Medicines that affect blood circulation in the peripheral blood vessels (in the fingers of the hands and feet), such as ergot alkaloids (which can be used to treat migraine).
• Medicines used to treat depression.
• Medicines used to treat other mental disorders.
• Antiretroviral medicines used to treat AIDS and some other diseases.
• Antihistamines (also available without a prescription, medicines used to treat hay fever and other allergies, colds, and other conditions).
• Medicines used to prevent malaria.
• Medicines used to treat fungal infections.
• Medicines that affect liver enzyme activity, rifampicin used to treat tuberculosis.
• Medicines used to treat heart function disorders (also angina pectoris), such as amiodarone, digoxin, nitrates, and anti-arrhythmic drugs.
• Other medicines that slow down heart rate: the use of fingolimod (a medicine used in adults, children, and adolescents to treat relapsing-remitting multiple sclerosis) with beta-blockers may enhance the heart rate slowing effect in the first few days after starting fingolimod.
• Other medicines that lower blood pressure: the use of aldesleukin (a synthetic protein used to treat kidney cancer with metastases to other organs) with beta-blockers may cause enhanced blood pressure lowering effect.
• Insulin and other anti-diabetic medicines.
• Non-steroidal anti-inflammatory drugs (NSAIDs), used to treat pain and inflammation.
• Local anesthetics containing lidocaine.
• A medicine called dipyridamole, which prevents blood clots.

Beto 200 ZK with food, drink, and alcohol

Beto 200 ZK and alcoholmay enhance each other's sedative effects. The blood alcohol concentration may reach higher values and decrease more slowly. During treatment with Beto 200 ZK, you should avoid drinking alcohol.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, you should consult your doctor or pharmacist before taking this medicine.
Pregnancy
Beto 200 ZK can be used during pregnancy only if clearly necessary and after a careful assessment by the doctor of the ratio of expected benefits to possible risks. There is evidence that metoprolol reduces blood flow in the placenta, which may lead to fetal development disorders.
Treatment with Beto 200 ZK should be discontinued 48 to 72 hours before the expected delivery date. If this is not possible, the doctor will closely monitor the newborn for 48 to 72 hours after birth.
Breastfeeding
Beto 200 ZK passes into breast milk.
Metoprolol should not be taken during pregnancy unless absolutely necessary.
Although the occurrence of side effects is unlikely when using the recommended doses, you should closely monitor the breastfed infant for possible symptoms caused by the medicine (e.g. the doctor will monitor the heart rate).

Driving and using machines

During treatment with Beto 200 ZK, dizzinessor fatiguemay occur. These symptoms may affect reaction speed to the extent that it impairs the ability to drive vehicles, operate machinery, and work in potentially hazardous conditions. Symptoms may occur especially when consuming alcohol, as well as when switching to another medicine.

Beto 200 ZK contains glucose, lactose monohydrate, and sucrose (sugar)

If you have previously been diagnosed with intolerance to some sugars, you should contact your doctor before taking Beto 200 ZK.

3. How to take Beto 200 ZK

This medicine should always be taken as directed by your doctor. If you are unsure, you should consult your doctor or pharmacist.
Available on the market are: Beto 25 ZK (23.75 mg), Beto 50 ZK (47.5 mg), Beto 100 ZK (95 mg), Beto 150 ZK (142.5 mg), Beto 200 ZK (190 mg).
Your doctor will inform you how many tablets and when to take them. The prescribed dose depends on the type and severity of the disease.

If your doctor has not prescribed otherwise, the following dosing is usually used:

High blood pressure

• Patients with mild to moderate hypertensionshould take 47.5 mgof metoprolol succinate once a day.
• If necessary, your doctor may increase the dose to 95-190 mgof metoprolol succinate once a dayor use an additional blood pressure lowering medicine.

Chest pain (angina pectoris)

• 95-190 mgof metoprolol succinate once a day.
• If necessary, your doctor may use an additional medicine used to treat coronary heart disease.

Heart rhythm disorders, including accelerated heart rate (arrhythmias)

• 95-190 mgof metoprolol succinate once a day.

Treatment after heart attack

• 190 mgof metoprolol succinate once a day.

Unpleasant sensation of irregular and/or strong heartbeat (palpitations)

• 95 mgof metoprolol succinate once a day.
• If necessary, your doctor may increase the dose to 190 mgof metoprolol succinate once a day.

Migraine prevention

• 95-190 mgof metoprolol succinate once a day.

Heart failure (heart failure)
Before starting treatment for heart failure, it is necessary to stabilize the patient's condition with medicines usually used to treat heart failure, and then adjust the dose of Beto ZK individually for the patient.

• The recommended initial dose in the first weekfor patients with heart failure(classified as heart failure grade III-IVaccording to NYHA) is 11.88 mgof metoprolol succinate once a day. Your doctor may increase the dose in the second weekto 23.75 mgof metoprolol succinate once a day. The recommended initial dose in the first 2 weeksfor patients with heart failure(classified as heart failure grade IIaccording to NYHA) is 23.75 mgof metoprolol succinate once a day.
• Then your doctor will double the dose. The dose can be doubled every two weeksuntil a dose of 190 mgof metoprolol succinate once a dayis reached or the maximum dose tolerated by the patient.
• The recommended dose for long-term maintenance treatmentis 190 mgof metoprolol succinate once a dayor the maximum dose tolerated by the patient.

Use in children and adolescents
High blood pressure:
In children over 6 years of age, the dose depends on body weight. Your doctor will determine the dose suitable for the patient.
Usually, the initial dose of metoprolol succinate is 0.48 mg/kg body weight once a day, but not more than 47.5 mg. The dose is adjusted to the nearest tablet strength. Your doctor may increase the dose to 1.9 mg/kg body weight, depending on the blood pressure response. In children and adolescents, doses above 190 mg per day have not been studied.
Beto 200 ZK should not be used in children under 6 years of age.
The duration of treatment is determined by your doctor.
If you feel that the effect of Beto 200 ZK is too strong or too weak, you should consult your doctor or pharmacist.

Elderly patients

No studies have been conducted in patients over 80 years old, so in such patients, your doctor will be particularly cautious when increasing the dose of the medicine.
Beto 200 ZK is intended for oral administration.
Tablets should be taken once a day, preferably during breakfast. Tablets can be divided into equal doses. They can be swallowed whole or divided, but you should avoid chewing or crushing them. Tablets should be taken with water (at least 1/2 cup).

Taking a higher dose of Beto 200 ZK than recommended

You should immediately consult your doctor or go to the emergency department of the nearest hospital. Based on the severity of the symptoms of poisoning, your doctor will decide what action to take.
You should show the packaging of the medicine to your doctor, so that it is known what medicine was taken and what action to take.
Symptoms of overdose
Symptoms that may occur as a result of an overdose of Beto ZK may include: dangerously low blood pressure, severe heart function disorders, breathing difficulties, loss of consciousness (or even coma), seizures, nausea, vomiting, cyanosis (blue or purple discoloration of the skin) and death.
Treatment of overdose
The patient should be treated in a hospital, in the intensive care unit. Even patients who seem to be in good condition and have only slightly overdosed on metoprolol should be closely monitored by a doctor for at least 4 hours for signs of poisoning.

Missing a dose of Beto 200 ZK

You should not take a double dose to make up for a missed dose, but continue treatment as directed by your doctor.

Stopping treatment with Beto 200 ZK

Before stopping or prematurely discontinuing treatment with Beto ZK, you should consult your doctor.
Beto 200 ZK should not be stopped abruptly, but the dose should be gradually reduced.
Sudden discontinuation of beta-blockers may cause worsening of heart failure symptoms and increase the risk of heart attack and sudden cardiac death.
If you have any further doubts about the use of this medicine, you should consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Very common (may affect more than 1 in 10 people):

• feeling of fatigue

Common (may affect up to 1 in 10 people):

• dizziness, headache
• slow heart rate (bradycardia),
• palpitations
• significant lowering of blood pressure, especially when changing position from lying to standing, very rarely with loss of consciousness
• cold hands and feet
• breathing difficulties during exertion in predisposed patients (e.g. patients with asthma)
• nausea, abdominal pain, diarrhea, constipation

Uncommon (may affect up to 1 in 100 people):

• weight gain
• depression, drowsiness, sleep disorders, nightmares, concentration disorders
• abnormal sensation of tingling, prickling, or numbness of the skin (paresthesia)
• transient worsening of heart failure symptoms (with ankle edema), first-degree atrioventricular block, chest pain (chest pain), poor heart function as a pump (cardiogenic shock) in patients with heart attack (acute myocardial infarction).
• bronchospasm (bronchospasm)
• skin rash (urticaria-like and dystrophic skin changes), increased sweating
• muscle cramps

Rare (may affect up to 1 in 1000 people):

• worsening of diabetes without characteristic symptoms (latent diabetes)
• nervousness
• visual impairment, dryness or irritation of the eyes (noticeable when wearing contact lenses), conjunctivitis
• heart rhythm disorders (arrhythmia), conduction disorders
• nasal congestion
• dry mouth
• abnormal liver function test results
• hair loss
• impotence and libido disorders, Peyronie's disease (plastic induration of the penis)

Very rare (may affect up to 1 in 10,000 people):

• decreased platelet count (thrombocytopenia), decreased white blood cell count (leukopenia)
• memory loss or memory disorders, confusion, hallucinations, personality changes (e.g. mood swings)
• ringing in the ears (tinnitus), hearing impairment
• tissue death (necrosis) in patients with severe peripheral circulatory disorders before treatment
• taste disorders
• hepatitis
• hypersensitivity to light with skin rashes after exposure to light, worsening of psoriasis symptoms, development of psoriasis
• joint pain, muscle weakness

Frequency not known (frequency cannot be estimated from the available data):

• abnormal blood levels of certain fats, such as cholesterol or triglycerides
• worsening of symptoms in patients with intermittent claudication or vasospasm of the fingers of the hands and feet (Raynaud's phenomenon).

Reporting side effects

If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety Monitoring, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: +48 22 49 21 301, fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Beto 200 ZK

• The medicine should be stored out of sight and reach of children.
• Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month stated.
• Store in a temperature below 25°C.
• Translation of some information on the immediate packaging: Charge: en EXP:zie zijkant- batch number and expiry date: see embossing.
• Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the packaging and other information

What Beto 200 ZK contains

The active substance is metoprolol succinate.
Each prolonged-release tablet contains 190 mg of metoprolol succinate.
Other ingredients are:sucrose, pellets (sucrose, corn starch, liquid glucose), polyacrylate dispersion 30%, talc (E 553b), magnesium stearate (E 470b), microcrystalline cellulose (E 460), crospovidone, silicon dioxide (E 551).
Coating: lactose monohydrate, hypromellose (E 464), titanium dioxide (E 171), macrogol 4000.

What Beto 200 ZK looks like and contents of the pack

White, oblong tablets, with a dividing line on both sides.
Prolonged-release tablets are packaged in PP/Aluminum or PVC-Aclar/Aluminum blisters and placed in a cardboard box.
Pack sizes: 30 and 60 prolonged-release tablets.
For more detailed information on the medicine, you should contact the marketing authorization holder or parallel importer.

Marketing authorization holder in the Netherlands, the country of export:

Sandoz B.V.
Veluwezoom 22
1327 AH Almere
Netherlands

Manufacturer:

Salutas Pharma GmbH
Otto-von-Guericke-Allee 1
39179 Barleben, Germany
Sandoz B.V.
Veluwezoom 22
1327 AH Almere, Netherlands
Lek Pharmaceuticals d.d.
Verovškova 57
1526 Ljubljana, Slovenia

Parallel importer:

InPharm Sp. z o.o.
ul. Strumykowa 28/11
03-138 Warsaw

Repackaged by:

InPharm Sp. z o.o. Services sp. k.
ul. Chełmżyńska 249
04-458 Warsaw
Netherlands marketing authorization number, country of export:RVG 32380
Parallel import authorization number:342/13
Date of leaflet approval: 11.05.2023
[Information about the trademark]